The Empty Chair Read Free Page A

through the preliminaries again. For both our sakes."
    Rhyme nodded curtly. He was prepared to tolerate some formality though he had little patience for ass-covering. Which is what this was starting to sound like.
    "You've read the literature about the Institute. And you know we're starting some trials of a new spinal cord regeneration and reconstruction technique. But I have to stress again that this is experimental ."
    "I understand that."
    "Most of the quads I've treated know more neurology than a general practitioner. And I'll bet you're no exception."
    "Know something about science," Rhyme said dismissively. "Know something about medicine." And he offered her an example of his trademark shrug, a gesture Dr. Weaver seemed to notice and file away.
    She continued, "Well, forgive me if I repeat what you already know but it's important for you to understand what this technique can do and what it can't do."
    "Please," Rhyme said. "Go on."
    "Our approach at the Institute here is an all-out assault on the site of the injury. We use traditional decompression surgery to reconstruct the bony structure of the vertebrae themselves and to protect the site where your injury occurred. Then we graft two things into the site of the injury: One is some of the patient's own peripheral nervous system tissue. And the other substance we graft is some embryonic central nervous system cells, which –"
    "Ah, the shark," Rhyme said.
    "That's right. Blue shark, yes."
    "Lincoln was telling us that," Sachs said. "Why shark?"
    "Immunologic reasons, compatibility with humans. Also," the doctor added, laughing, "it's a damn big fish so we can get a lot of embryo material from one."
    "Why embryo?" Sachs asked.
    "It's the adult central nervous system that doesn't naturally regenerate," Rhyme grumbled, impatient with the interruption. "Obviously, a baby's nervous system has to grow."
    "Exactly. Then, in addition to the decompression surgery and micrografting, we do one more thing – which is what we're so excited about: We've developed some new drugs that we think might have a significant effect on improving regeneration."
    Sachs asked, "Are there risks?"
    Rhyme glanced at her, hoping to catch her eye. He knew the risks. He'd made his decision. He didn't want her interrogating his doctor. But Sachs' attention was wholly on Dr. Weaver. Rhyme recognized her expression; it was how she examined a crime scene photo.
    "Of course there are risks. The drugs themselves aren't particularly dangerous. But any C4 quad is going to have lung impairment. You're off a ventilator but with the anesthetic there's a chance of respiratory failure. Then the stress of the procedure could lead to autonomic dysreflexia and resulting severe blood pressure elevation – I'm sure you're familiar with that – which in turn could lead to a stroke or a cerebral event. There's also a risk of surgical trauma to the site of your initial injury – you don't have any cysts now and no shunts but the operation and resulting fluid buildup could increase that pressure and cause additional damage."
    "Meaning he could get worse," Sachs said.
    Dr. Weaver nodded and looked down at the file, apparently to refresh her memory, though she didn't open the folder. She looked up. "You have movement of one lumbrical – the ring finger of your left hand – and good shoulder and neck muscle control. You could lose some or all of that. And lose your ability to breathe spontaneously."
    Sachs remained perfectly still. "I see," she said finally, the words coming out as a taut sigh.
    The doctor's eyes were locked on Rhyme's. "And you have to weigh these risks in light of what you hope to gain – you aren't going to be able to walk again, if that's what you were hoping for. Procedures of this sort have had some limited success with spinal cord injuries at the lumbar and thoracic level – much lower and much less severe than your injury. It's had only marginal success with cervical injuries and none at all